Costs are soaring even as state considers further cuts to care programs

In Los Angeles County, being disabled can cost a year's income. That's because the annual cost of in-home care services for seniors living alone is now $319 more than this group's median income of $17,029.

Combine long-term care expenses with other basic expenses, such as food and rent, and a Los Angeles senior living alone will need twice the median income to survive, according to new data released today by the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development.

In all 58 California counties, long-term health care is far out of reach for the state's most vulnerable citizens: seniors living alone who are disabled. Yet even as costs soar, Gov. Arnold Schwarzenegger has proposed the elimination of Medi-Cal–funded in-home supportive services for up to 400,000 seniors as a means of closing the state's budget gap.

"In all 58 counties, long-term care paired with basic living expenses exceeds median income," said Jenny Chung, attorney and program manager at the Insight Center. "Seniors can't afford care as it is. How are they going to cope with cuts?"

In 33 counties (57 percent of all California counties), the cost of long-term health care for elderly single women — who are more likely than men to use long-term care — exceeds the median income for single Californians aged 65 or older. In 38 counties (65.5 percent of all counties), the cost of long-term care combined with basic living expenses is at least two times themedian income for this group. And in all 58 California counties, long-term care paired with basic living expenses far exceeds median income.

"When getting help at home costs a year's income, something's wrong," said Steven P. Wallace, associate director of the Center for Health Policy Research. "It means that extended families will be stretched thin to provide care or that the elderly will bankrupt themselves to pay for a service provider."

The new data provides county-by-county estimates of long-term care costs, as well as long-term care costs paired with basic living expenses. These basic living expenses are estimated using the Elder Economic Security Standard Index, or Elder Index, a tool that measures the actual costs of basic necessities for older adults in each of California's counties.

The researchers have created an accompanying table in which these costs are paired with median income — a measure of Social Security, pensions and other income for retired Californians age 65 and older who are living alone. The table, which can be sorted, can be accessed on the websites of the Center for Health Policy Research and the Insight Center.

Researchers found that the cost of a "medium" amount of long-term care — 16 hours a week — was often equal to or greater than the median income that single female seniors receive from Social Security, pensions and other sources.

When other basic living expenses were factored in, total costs nearly doubled or tripled.

Researchers used the "medium" level of long-term care as a measure because it is the most representative amount of care used by seniors in California. Female seniors living alone are the group most likely to need paid in-home assistance when they become disabled.

Approximately 973,000 California seniors live alone. Of these, 50 percent do not have enough income to meet basic expenses, as defined by the Elder Index.

Long-term care is not covered by most insurance policies. Only the lowest-income seniors in California can receive in-home care services through the state's Medi-Cal program. However, due to the state budget crisis, services for all but the most severely disabled may soon be cut.

"The only alternative, that no one wants, is going to a nursing home where Medi-Cal will eventually pick up the cost," Wallace said. "But Medi-Cal will only pay if a senior is extremely poor. Which means many seniors are caught in the middle — with too little money to afford in-home services and too much to qualify for a Medi-Cal nursing home."

Among the researchers' findings:

Contra Costa and San Francisco counties have the highest long-term care costs: $21,043 and $21,011, respectively. Yet the median income for single seniors living alone is $23,985 in Contra Costa County and $16,792 in San Francisco County.

The cost of long-term care paired with basic living expenses is highest in San Francisco and San Mateo counties: $48,446 and $48,441, respectively.

In 38 counties (65.5 percent of all counties), the cost of long-term care paired with basic living expenses is twice the median income. In at least one county, Alpine, these costs are three times the median income.

Orange County ranked the lowest of all 58 counties in terms of long-term care costs: $17,136. However, when long-term care costs are paired with basic living expenses, Orange County becomes one of the most expensive places for seniors. Long-term care costs plus basic living expenses are $42,603, raising Orange County to 11th out of 58 counties and illustrating the toll that rents and other necessities exact on seniors in expensive areas.

The Elder Economic Security Standard Index quantifies the actual costs of meeting basic necessities for older adults in each California county. The Elder Index is currently under consideration by the California Legislature as a planning tool for state aging-services programs. For more information on the Elder Standard Index, click here.